Whatsa Prolapse?

Whatsa Prolapse and What Can I Do About It?
 
Long time, no blog.  My apologies!  It's time to get back in the proverbial saddle (no horses on the farm anymore) and blog a bit…… it's all in the effort to help women and their healthcare professionals, their partners, friends, sisters, coaches and more understand women's amazing bodies.
 
So……whatsa prolapse?  Most women experience a pelvic organ prolapse or dropping of their pelvic organs at some time in their lives….it's in the neighbourhood of 70% of us, depending on which study your read.  Dropping or descending of your bladder/urthrea, rectum/lower bowel, cervix/uterus (and rarely your small intestine and other higher-up organs) is common; it feels like pressure, weightiness, a dragging sensation that is often relieved by lying down (overnight), antigravity positions (legs up the wall) and penetrative sex with a man (the penis helps nudge things back in place).  As we work through our day and especially when we're doing a lot of heavy leaning forward and effortful work, we notice the pressure in our pelvic floor, the vagina (the inside) and the vulva (the outside) more and more.
 
Why does this happen?  Life and all its experiences and joys and challenges can bring prolapse into our lives.  Think pregnancy, labour, delivery and postpartum times…..pregnant heaviness on your pelvic system, pushing hard in delivery for more than one hour, a tear or episiotomy at your perineal body (the thick and strong spot between your anus and the base of your vulva) and lots of leaning forward work of new parenthood (breastfeeding, diapering, bathing, snuggling on a tired and hormonally released body).  Having multiples (yay fellow Moms of twins and more!), babies who arrive at more than 8 pounds, forceps and vacuum deliveries, more than 3 deliveries also add to the mix.  Then, you might add in being overweight (belly fat adds downward pressure), having a persistent cough (asthma, COPD, smoking, allergies….), doing heavy physical work,  doing leaning forward work (sitting, gardening, lifting +++…), chronic constipation/bearing down on the toilet and impact sports (basketball, running, power lifting….).  How we sit (cross your legs/feet and slouch), how we breathe, how we move, how we live in and above our pelvic system adds some more prolapse factors.  Now……think about lovely postmenopause.  Remember that menopause is that moment when you are one year past your last cycle.  You shift from perimenopause to postmenopause in an instant.  The loss of spunky estrogen, the hormone that supports your muscles to be active, thick, juicy and responsive, means you lose some of the natural hormonal support of your organs.  After reading this list, you see why most women prolapse at some time in our life.
 
How do we test for prolapse?  We pelvic physios follow a testing protocol that is well researched and supported.  During your pelvic exam, we figure out where your organs are at rest, then we ask you to take in a deep breath and bear down.  We measure, with our finger or a POP stick, the descent of the organs down your vaginal vault.  The "gold standard" of testing involves you doing 6 repetitions of 6 seconds of bearing down with a wee break in between.  But, that's not all!  We also measure the quality and speed along with the amount of natural retraction of your organs between each bearing down.  We might ask you to lift your pelvic floor, to try a different position, to breathe out with an anal squeeze or a hypopressive manoeuver so we can sleuth out how you can help lift your organs yourself.  It's all about finding out what works specifically for you once we see that you're prolapsed.  We "stage" the prolapses out of 4.  If you have a stage 1 prolapse, it's pretty minimal and possibly inconsequential……this means that your organs are descending to less than ½ way down your vaginal vault on bearing down, it doesn't worsen as you repeat it and they mostly return to their starting position in between.  If you're at a stage 2, your organs are descending to the "introitus" or the opening of the vaginal vault at the vulva.  At stage 3, the organs go beyond that and poke out past the opening and stage 4 means they're mostly living there.  Women at stage 3 and 4 might describe a constant pressure that worsens with toileting and a scraping or bulging on wiping after BMs and voids.
 
 
 
 
Why do prolapses happen?  Big friendly letters - It's Not Because You Have a Weak Pelvic Floor!  Repeat after me!!!!  Prolapses happen because your pelvic organ support system, the core cylinder of your central body, has some pressure management fault.  There is a natural support system on every breath and every movement that moves your thorax to abdomen to pelvis that involves your pelvic organ support.  It's supposed to keep supporting your organs as you go through life!  But there are times in a woman's life when we ask more of the system than the support system can manage, so we develop coping strategies that create prolapse and/or we don't find pelvic organ lifting as we need in a day.
 
What can you do about it?  Brace yourself - SO MUCH!  Simply change how you breathe, sit, move, eat and toilet and you're all set!  If you have an intractable stage 3 or full stage 4 prolapse, you'll be referred to a gynie surgeon who might offer to tack up your organs onto your pelvic ligaments/fascia.  But, please see a pelvic physio in the meantime so that the habits and situations that caused your prolapse are sleuthed out and you don't return to said surgeon for round #2.  At stage 1, you're probably post partum or early perimenopause and might be just fine.  I'd still recommend that you check it out with a pelvic physio so that your prolapse doesn't progress.  Stage 2 and early stage 3 brings you the opportunity to meet in the clinic - you can learn to lift your organs with some lifestyle changes, some adaptations to what and how you do what you do, some strengthening and postural exercises and perhaps referral to other options like hypopressive training, postural work, yoga therapy and  more!  Don't stop doing what you love to do but learn to do it with joy and employ clever lifting of your organs.  As a previously prolapsed postmenopausal woman, I run, work hard on our farm, lift haybales (repeatedly and often) and am no longer prolapsed.  It takes attention, training and time, but it's so worthwhile.
 
What else do you need to know?  You may have postmenopausal urogenital syndrome (vaginal atrophy) that's contributing to your prolapse.  Address that.  You might have interrupted or double voiding or persistent urinary tract infections.  Address that.  You might need to splint your anorectal system to poop effectively or be constipated all the time.  Address that.  You might have other spinal issues that are contributing.  Address that.  If you're carrying extra weight on your tummy, it's pushing on your prolapse.  Address that.  And your cough, COPD, smoking, allergies, posture, heavy lifting……what things can you begin to address that will already help your organs lift and be perky again?
 
The important bit = Prolapses happen to most of us and are common, but they're not normal nor acceptable.  Ask at your next PAP smear or seek a pelvic physio to help you learn to have happily supported pelvic organs, a strong deep core, brilliant voiding and pooping and a happy pelvic life throughout your seasons!